Speech therapy (language evaluation)
Facility: Mcpherson Hospital
Billing Code: 92507 (CPT)
- CPT Billing Code: 92507
- Insurance Median: $284
- Cash Discount Price: $275
- vs. Medicare Baseline: 3.73x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $76.15 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 373% of the Medicare baseline (a markup of 273%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Tricare | $64 | 84% |
| Va Ccn - All Plans | $73 | 96% |
| Wellcare Mcr Adv - All Plans | $73 | 96% |
| Humana | $73 | 96% |
| Blue Cross Blue Shield | $73 | 96% |
| UnitedHealthcare | $73 - $371 | 96% |
| Healthy Blue Mcr Adv | $73 | 96% |
| Ambetter / Centene | $84 | 110% |
| Wppa - All Plans | $260 | 341% |
| Medical Associates - All Plans | $278 | 365% |
| Central Plains - All Plans | $278 | 365% |
| Christian Health Aid - All Plans | $297 | 390% |
| Aetna | $306 - $371 | 402% |
| Multiplan - All Plans | $334 | 439% |
| First Health - All Plans | $352 | 462% |
| Health Partners - All Plans | $352 | 462% |
| Cigna | $352 | 462% |
| Medicaid / KanCare | $371 | 487% |
| Health Blue Mcaid - All Other Plans | $378 | 496% |
Consumer Guidance & Cost Commentary
For this speech therapy evaluation at Mcpherson Hospital, the cash price of $275 is lower than the negotiated rates paid by most insurance plans, which range from $260 to $371. While the facility's cash rate is slightly below the state average of $293, patients with high-deductible plans may find paying out-of-pocket initially more cost-effective than relying on insurance, as many commercial payers allow amounts exceeding the cash price. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can significantly reduce the final cost.
The facility's negotiated rates vary widely depending on the insurance carrier, with UnitedHealthcare and Aetna showing the highest variability, while Medicaid/KanCare and Tricare match the gross charge of $371. When comparing these commercial rates to the Medicare benchmark of $76.15, the facility's pricing reflects a significant markup, which is common in the healthcare industry but warrants scrutiny. To ensure you are not overcharged, request a full itemized bill that breaks down every CPT code and service rendered, as summary bills often hide unbundled charges or services not actually provided. If you receive a large bill after insurance processing, do not pay immediately; instead, dispute the charges in writing to request a line-by-line audit and confirm that all services match your medical records.